August 29, 2013. The folds of the outer surface of the brain may provide insight into which patients will respond well to antipsychotics during their first bout of psychosis, according to a new study published online August 14, 2013, in JAMA Psychiatry. Researchers led by Lena Palaniyappan of the U.K.’s University of Nottingham examined these folds using high-resolution images of the brain shortly after patients were diagnosed with psychosis for the first time. The patients were then treated as they normally would have been and, as expected, some responded better than others to the various antipsychotic medicines.

Later, the researchers divided the patients into those who responded—partly or fully—to antipsychotics and those who did not. When they went back to the brain images, the researchers found that non-responders showed less folding in several brain regions than did the treatment responders, whose brains were nearly indistinguishable from those of their healthy counterparts. The hope for this sort of analysis is that it could someday be used to predict which patients should be directed into alternative treatment plans.

The study also found that brain surface folding differed across psychosis diagnoses. Those whose psychosis did not include a significant mood component (including patients with schizophrenia) had more folding deficits than those whose illness was mood based (patients with bipolar disorder and major depression with psychosis). Because the folds of the brain develop most rapidly early in life, these results are consistent with the well-supported idea that schizophrenia is characterized by more developmental abnormalities than bipolar disorder or depression. (For more details, see the related news story.)—Allison A. Curley.